Objective: To evaluate and demonstrate the accuracy of fine-needle aspiration (FNA) in thyroid lesions in our department and to highlight probable causes of errors leading to unsatisfactory sampling, which may depend on the characteristics of the nodule. Methods: This is a retrospective study conducted on 319 diagnosed cases of thyroid nodules referred to the Surgery Unit of Puls hospital, Tîrgu Mureș in the January 2014 – December 2015 period, who underwent fine-needle aspiration. Histological examination was considered to be the gold standard; therefore we compared the cytological diagnosis with the histological one. Results: Of the 319 cases, 289 (90.6%) were female and 30 (9.4%) male patients; 210 cases (69.3%) were interpreted as benign, 46 cases (15.2%) as follicular lesion of undetermined significance, 4 cases (1.3%) as suspect for malignancy, 1 case (0.3%) as malignant sampling, and 42 cases (13.9%) as unsatisfactory. We compared the results of fine-needle aspiration cytology (FNAC) with the corresponding histopathological results (49 in total). FNAC achieved a sensitivity of 76.47%, a specificity of 83.1%, a positive predictive value of 35.1%, a negative predictive value of 96.7%, a false positive rate of 16.9%, a false negative rate of 23%, and an overall accuracy of 82.3%. Conclusions: The results of our study demonstrate the accuracy of the FNA technique in the first-line diagnosis of thyroid nodules.

Introduction: Graves’ disease (GD), an autoimmune disorder caused by high levels of auto-antibodies against the thyroid-stimulating hormone receptor, is considered the most common cause of thyrotoxicosis, characterized by features such as goiter, ophthalmopathy and dermopathy. In our country, the administration of antithyroid drugs (ATD) is the first line of treatment in this disease. Side effects are rare but some of them, such as agranulocytosis or liver damage, may become serious. Case presentation: We report the case of a 20-year-old female patient who was diagnosed with GD after being previously diagnosed with viral hepatitis A. Treatment was initiated with methimazole 30 mg/day, and three weeks later she developed intense hepatic cytolysis and cholestatic syndrome, therefore the ATD was stopped. A suspicion of autoimmune liver disease was raised, and a liver biopsy was performed in order to establish the diagnosis. The next therapeutic option for hyperthyroidism was radioactive iodine (RAI). Three months following RAI, the patient presented severe hypothyroidism, thereupon treatment with levothyroxine was initiated. Conclusions: Although severe acute liver injury is rare, mild liver dysfunction is quite common in patients with GD. The overproduction of thyroid hormones, or the treatment with ATD through immune mediated processes or drug reactions, represent possible mechanisms responsible for liver damage.